Search

RESUMEN: La clasificación de los Tumores Primarios del Sistema Nervioso Central (SNC) tiene su origen en la descripción morfológica, cuyo análisis histopatológico ha permitido identificar la línea celular involucrada en estos tumores y obtener el reconocimiento de ciertas características de estas lesiones y su evolución clínica. El estudio molecular ha venido a complementar el diagnóstico inicial permitiendo reconocer entidades que no son distinguibles de otra manera y que han variado los conceptos y definiciones de varias entidades patológicas que modifican el horizonte visible de estas enfermedades. El papel de las imágenes de Resonancia Magnética (RM) en el manejo de los tumores intraaxiales se puede dividir ampliamente en el diagnóstico y la clasificación de los tumores, la planificación del tratamiento y el tratamiento posterior. El presente artículo resume la evidencia epidemiológica relacionada en la clasificación de los tumores primarios del SNC con marcadores moleculares y biomarcadores de imágenes de RM, apuntando a la importancia del uso de la investigación clínica con el manejo terapéutico.

Vestibular Schwannomas (VS) are benign intracranial tumors, for which their current management is a matter of debate, although microsurgical treatment remains the mode of choice in the majority of cases.To describe the surgical outcome of patients operated on for a VS in a Chilean Public Hospital.A series of 67 patients treated surgically between 2002 and 2012, in the Institute of Neurosurgery Asenjo is presented.Sixty-five cases (97%) corresponded to Koos III and IV tumors, of which 52% were large (3-4 cm) or Giant (4 cm). Forty-one cases were operated on using a retrosigmoid transmeatalapproach (61%). Total resection was achieved in 97% of the cases and subtotal in the remaining 3%. A mean six months follow-up showed that good facial function (House-Brackmann I or II) was obtained in 32.7% of the patients, and moderate function (House-Brackmann III or IV) in 42.3%. Cardiopulmonary complications were the most frequent (28%), and mortality was 1.5%.The VS are tumors that can cause significant neurological deficit in advanced stages, despite their benign nature. Surgical treatment is very complex, and must be performed by specialized teams to ensure optimal functional results.

La acromegalia es una enfermedad cronica causada en la mayoria de los casos por un adenoma hipofisario. Su manejo es complejo por la gran variabilidad de la lesion causante y su repercusion clinica. Los resultados quirurgicos son pobres, con tasas de remision de la enfermedad en promedio de un 80% en microadenomas y 50% en macroadenomas. Se presenta la experiencia del autor en el manejo de esta patologia en 38 pacientes, los resultados de remision de la enfermedad. Se discute las alternativas de manejo, complicaciones asociadas y se ilustra con un caso clinico para demostrar las opciones terapeuticas en los casos mas complejos.

We discuss revascularization techniques for complex skull base lesions utilizing high-flow arterial bypass. At present, the radial artery is the donor graft utilized in most circumstances at our institution. The knowledge of revascularization techniques is very important to achieve radical resection in lesions where arterial compromise is documented.

OBJECTIVE: Intraoperative color Doppler ultrasound has been used to locate arteriovenous malformations (AVMs). We describe the use of spectral Doppler to measure flow resistance and resistive index (RI) of vessels around the nidus to distinguish feeding arteries from en passant and normal vessels. This is particularly helpful in small AVMs and aids in the identification of normal vessels and completeness of resection by ruling out persistent low RI flow. METHODS: Seven patients with AVMs underwent resection. Speciral Doppler applied to the vessels In proximity to the AVM, along with calculated RI, was used to identify feeding arteries and draining veins. After presumed surgical resection of the AVM, pre-resection and postresection RIs were compared to identify residual AVM. Postoperative angiography was performed in all seven patients to confirm complete resection of the AVM. RESULTS: The mean pre-resection RI of vessels feeding the AVM was 0.34 (±0.01). In five patients without residual nidus on the basis of postresection color Doppler and postoperative angiogram, the postresection RI was 0.62 (±0.04). In two patients, the pustresection scan identified a nidus with persistent low RI flow. Once residual AVM was resected, the RI became significantly higher. A postoperative atigiogram confirmed complete resection of the AVM in all patients. CONCLUSION: Intraoperative duplex Doppler allowed more accurate localization of the AVM nidus. RI of the vessels around the AVM helped to distinguish vessels feeding the AVM from en passant vessels. Furthermore, comparison of pre-resection and pustresection. RI accutately indicated the completeness of resection.

Los cavernomas o angiomas cavernosos son malformaciones hamartomatosas vasculares benignas, en su mayoría encefálicas y supratentoriales, con prevalencia descrita entre el 0,1 y el 4% de la población general, de presentación esporádica o familiar. El presente estudio analiza los aspectos epidemiológicos, clínicos y pronósticos de los casos tratados en el Instituto de Neurocirugía Asenjo durante el año 2000. Para ello se recopiló información de 13 casos operados desde las fichas médicas y de los protocolos operatorios, registrándolos en una matriz Excel® para su análisis. Los resultados permiten concluir que el cuadro clínico de presentación es de tipo comicial en la mayoría de los pacientes de nuestra serie. La cirugía se plantea sólo en los casos sintomáticos. En nuestro centro las cifras de morbimortalidad son similares a las presentadas en la literatura internacional. Las lesiones profundas son un desafío por la dificultad técnica de los accesos y porque están asociadas a mayores complicaciones Cavernomas, or cavernous angiomas, are benign vascular hamartomatous malformations; they are almost always located supratentorially in the brain. The prevalence is about 0.1 to 4% of the general population, and they may arise in sporadic or familial forms. The present study analyzes the epidemiological, clinical and outcome characteristics of a series of cavernomas treated at the Asenjo Institute of Neurosurgery during 2000. The data of 13 patients who were surgically treated was obtained from clinical and surgical records, and compiled in an Excel database for analysis. The results show that convulsive syndrome is the most frequent symptom. Surgery is reserved only for patients with symptomatic lesions. In our institution, morbimortality rates are similar to those published in the current international literature. Deep-seated lesions are a challenge due to the technically demanding surgical procedures needed for treatment and higher rates of complications